Pillar 1: therapeutic endoscopy

Endoscopy, a non-surgical procedure in which a physician inserts a slim flexible tube with an integrated video camera into the stomach (gastroscopy) or colon (colonoscopy), plays a critical role in early diagnosis of GI cancers.

The St. Paul’s Hospital Advanced Endoscopic Resection Centre (SPARC), co-founded by Dr. Eric Lam and Dr. Neal Shahidi, is a tertiary referral centre that offers minimally invasive alternatives to surgery. These techniques provide patients afflicted with these lesions with organ-sparing alternatives that are safe and less costly to our healthcare system. The majority of SPARC patients are from British Columbia, with some seeking out St. Paul’s Hospital from neighbouring provinces.

SPARC is also the largest referral centre in Western Canada for peroral endoscopic myotomy, an innovative tunnelling technique for the treatment of achalasia, a rare disorder that makes it difficult for  food and liquids to pass from the esophagus into the stomach, as well as other disorders affecting the esophagus and stomach.

Within the DHC, an Endoscopic and Surgical Simulation Centre will be installed as a leading-edge space where trainees and mentors can develop and test innovations in surgical and therapeutic endoscopic techniques.

Giving patients more access to outpatient colonoscopy procedures in a timely manner is central to the team’s mission to find abnormalities quickly and early. Quicker, more efficient diagnoses of cancers and other serious illnesses, and empowering patients with access to holistic care and multidisciplinary expertise, places them on the right path to manage their disease and ensures promising outcomes for their health and wellbeing.

Pillar 3: colorectal surgery

Of the 15 fellowship-trained colorectal surgeons in BC, five will be based at the DHC. It will be the provincial centre of excellence in this field for surgical treatment of colorectal cancer, IBD and all other colorectal disorders for patients from BC and Yukon.

The highest volume of surgery in Western Canada in these areas is currently performed at St. Paul’s Hospital, which is a hub of multidisciplinary care for the province. St. Paul’s surgeons are Canadian pioneers in some of the most innovative, minimally invasive techniques for rectal cancer surgery, and experts in managing the most complex patients referred from across BC. They also have strong, collaborative ties to oncologists at BC Cancer centres across the province.

Currently, the Provincial Health Services Authority and St. Paul’s are building a formal colorectal cancer partnership, which will be based out of the Digestive Health Centre. Here, patients will receive a full spectrum of care, from diagnosis to treatment and long-term follow-up. Patients who need to see three or four caregivers will be seen in one appointment, with surgeons and oncologists coming to the patient rather than the reverse, greatly expediting care.

Patients with these often debilitating diseases involving GI function have complex needs that are best managed by allied healthcare workers before and after surgery. At the DHC, patients will have access to the full gamut of specialists, from stoma nurses and wound care specialists to physiotherapists, nutritionists and dietitians.

As many colorectal surgical diseases involve multidisciplinary care, training must constantly evolve. The St. Paul’s Colorectal Surgery Centre is one of five nationally recognized and Royal College-accredited fellowship training programs in Canada. At the DHC, surgeons in training will become some of the best-trained colorectal surgeons in the world thanks to close proximity to all specialists, including non-surgeons, to broaden their experience.

Finally, as multidisciplinary care evolves, research studies will become collaborative between surgeons and gastroenterologists. With physical adjacency, common databases and clinical informatics, joint research personnel and a creative culture nurtured in a new environment, the DHC will foster some of the most innovative and groundbreaking GI research in the world.

Pillar 5: liver disease

There are more than 100 liver diseases caused by a variety of factors, such as viruses, toxins, genetics and alcohol. According to the Canadian Liver Foundation, nearly one in four Canadians suffer from liver disease.

More than seven million people in Canada experience the debilitating effects of non-alcoholic fatty liver disease, and this number is projected to increase dramatically due to the growing rates of obesity and type 2 diabetes.

There is often stigma around liver disease, related to alcohol and viral liver disease, and hepatitis B and C. An estimated 250,000 to 400,000 people in Canada are infected with hepatitis C, with a large proportion unaware of having the disease.

Certain liver diseases are more common among members of the Indigenous community, newcomers to Canada, persons living with addictions and/or mental health issues, and other marginalized populations. Our team is dedicated to using a compassionate, culturally safe and sensitive approach to these populations in the hope of lowering barriers to care, irrespective of demographics or geography.

Hepatologists—specialists in the evaluation and management of liver disease—at St. Paul’s Hospital (whose new home will be at the Digestive Health Centre) have strong collaborations locally, provincially and nationally thanks to well-established networks. Provincially, they coordinate a network for collaboration for hepatitis C care, have developed liver educational programs and ECHO-like programs, and collaborate with the BC Centre for Disease Control.